Popliteal Vein

Labs Cr 1.2 mg/dL, international normalized ratio (INR) 1.1, activated partial thromboplastin time (aPTT) 35 seconds, hematocrit (Hct) 38%, platelets 247,000/mm. Doppler ultrasound Partial noncompressibility of the left popliteal vein, nonocclusive clot. Ventilation-perfusion scintigraphy High probability for acute pulmonary embolism. Unmatched ventilation perfusion defect is seen in the left lower lobe. 

Y. Hosoi, H. Yasuhara, H. Shigematsu, T. Komiyama, A. Ono-zuka, and T. Muto, Influence of Popliteal Vein Thrombosis on Subsequent Ambulatory Venous Function Measured by Near-Infrared Spectroscopy, Am. J. Surg. 177(2), 111-116 (1999). 

A woman stabilised on warfarin 5 mg daily, with INRs between 2 and 3, started taking mesalazine 800 mg three times daily for the treatment of a caecal ulcer. Four weeks later she presented to hospital with left leg pain, which was diagnosed as an acute popliteal vein thrombosis, and at the same time it was found that her prothrombin time and INR had fallen to 11.3 seconds and 0.9, respectively. The patient was treated with intravenous heparin. Over the next 10 days INRs of up to 1.7 were achieved by increasing the doses of warfarin up to 10 mg daily, but a satisfactory DSTR of 2.1 was only reached when the mesalazine was stopped. The report says that serum warfarin levels were not detectable during the use of mesalazine. For diseussion of a patient who had a reduction in the response to warfarin when switehed from mesalazine to sulfasalazine, see below. 

A 47-year-old woman with schizophrenia was found dead in her apartment. She had been taking lithium and olanzapine. Autopsy showed an acute pulmonary embolus in the left main pulmonary artery, with extension into the lobar branches and an adherent thrombus in the left popliteal vein. There was no evidence of other pathology. Postmortem toxicology confirmed the presence of olanzapine and showed no other substances. There were no other risk factors, such as obesity, a sedentary lifestyle, a history of smoking, recent trauma or immobilization, use of estrogens, or a family history of thrombotic events factor V Leiden and prothrombin mutations were negative. 

The SSV begins on the lateral aspect of the foot, ascends posterior to the lateral malleolus and then up the midline of the calf, between the same fascial planes as the GSV. The SSV runs adjacent to the sural nerve (sensory) from just below the popliteal crease to the foot. In about two thirds of cases, the SSV drains into the popliteal vein at or just above the popliteal crease. In about one third of cases it has a cephalad extension with or without a saphe-nopopliteal junction (SPJ) to ultimately drain into... 

The popliteal artery is susceptible to injury due to its proximity to the distal femur and the knee joint. Its occlusion is encountered in 30-50% of patients with knee dislocation (Wright et al. 2004). Occasionally, US can identify popliteal pseudoaneurysms, which may be related to osseous abnormalities such as hereditary multiple exostoses and femoral osteochondromas (Fig. 14.111) (Chamlou et al. 2002 Klebuc et al. 2001). Thrombosis or varicosities of the popliteal vein and its afferent branches can also be diagnosed with US and Doppler techniques (Cronan et al. 1987 Fraser and Anderson 1999). 

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